Healthcare Provider Details

I. General information

NPI: 1285574202
Provider Name (Legal Business Name): STEVE AMBROSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 1615
CHICAGO IL
60602-1882
US

IV. Provider business mailing address

209 10TH AVE S STE 350
NASHVILLE TN
37203-4166
US

V. Phone/Fax

Practice location:
  • Phone: 312-967-9678
  • Fax:
Mailing address:
  • Phone: 615-345-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180018059
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: